Physical treatments for headache: a structured review

Area of Science:

• Neurology
• Physical Medicine & Rehabilitation

Background:

• Primary headache disorders, including migraine, often present with neck pain.
• Physical therapy and other physical treatments are frequently recommended for headache management.
• This review synthesizes evidence on physical modalities for primary headache disorders.

Purpose of the Study:

• To review and synthesize evidence on the efficacy of physical treatments for primary headache disorders.
• To update and assess published clinical trial evidence, systematic reviews, and case series.

Main Methods:

• Searched MEDLINE, Cochrane Library, and other sources through June 2004.
• Included English-language studies on chiropractic, osteopathic, physical therapy, or massage for headache or migraine.
• Assessed clinical studies, systematic reviews, and case series.

Main Results:

• Physical therapy is more effective than massage or acupuncture for tension-type headaches (TTH).
• Physical therapy combined with biofeedback, relaxation, and exercise is most effective for migraine.
• Chiropractic manipulation shows a trend for TTH benefit, but evidence is weak; it's more effective for TTH than migraine.

Conclusions:

• High-quality studies are needed to confirm the role of physical modalities in headache treatment.
• Most physical treatments are unlikely to be dangerous, but costs and opportunity costs are considerations.
• Physical treatments should complement, not replace, established therapies, with cautious, individualized decisions advised.